Background Obesity is on the rise, driven in part by changing patterns in food consumption. Nutrient profiling systems (NPSs) aim to guide healthier food choices through labeling and consumer facing technologies that highlight food quality.

Objectives This study compares four leading NPSs—Nutri-Score (NS), Health Star (HS), NOVA Classification (NC), Food Compass 2.0 (FC) – with nutrient ratios and a nutrient-ratio-based NPS, Nutrient Consume Score (NCS), for their associations with obesity and blood pressure in the U.S. population using NHANES data.

Methods NHANES (2015–2016) was analyzed for adults aged 20 and older. Dietary intake was assessed via 24-hour recalls, and NPS scores were calculated. Multivariable regression models adjusted for lifestyle factors were used to assess associations with obesity and blood pressure measures.

Results All NPSs and nutrient ratios were significantly correlated with healthier weight and showed variable associations with blood pressure. Incorporating alcohol and adjusting for bioactives in a ratio-based NPS improved its association with weight outcomes. The food categories contributing to high and low scores were largely consistent across NPSs.

Conclusions The NPSs and nutrient ratios evaluated were significantly associated with obesity and blood pressure measures. Intervention studies offering real-time NPS feedback on individual food choices are needed next to evaluate for causal impact of NPSs on metabolic health.

C.L.F. is an Associate Editor for Journal of Nutrition and Annals of Epidemiology, and works as a consultant for EpidStrategies, LLC. C.J.D. is editor-in-chief at GutBites MD, a not-for-profit web site intended for public good. He is on the scientific advisory board at Supergut, One Bio, and Oobli.

This study did not receive any funding

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This study used only openly available human data that were originally located at NHANES 2015-2016 Overview (https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/overview.aspx?BeginYear=2015)

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NHANES data used in this work is freely available from the National Center for Health Statistics. Other data described in the manuscript and a code book will be made available upon request pending approval.